Health Column: The vitamin D firestorm
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
“I wanna get my vitamin D level checked, doc.”
The vitamin D testing industry sky rockets!
“Experts” in vitamin D testing argue the appropriate doses of vitamin D in food, sunshine and tablets. There is universal agreement that vitamin D is an important nutrient in helping the body absorb calcium. There is no data to suggest that vitamin D has any useful effect on any other body system, including protection against influenza or colds.
In late November 2014, the U.S. Preventive Services Task Force (USPSTF) released their recommendations regarding vitamin D testing and treatments. After analysis of all the data, this least biased of all guideline groups, the USPSTF, concluded that there is no convincing evidence for or against Vitamin D screening in persons with no symptoms. It’s the kind of recommendation that leaves physicians and patients with that empty feeling, like kissing your sister or sitting through a four-hour athletic event that ends in a tie.
WHY SUCH AN AMBIVALENT GUIDELINE?
There are several reasons. First, nutritional guidelines are difficult to create. There are huge variations in intake of nutrients among different cultures. In 2010, the Institute of Medicine concluded that most people in the U.S. and Canada already have adequate vitamin D levels. People of color tend to have lower blood levels of vitamin D levels than whites, but African-Americans utilize the vitamin D they do have, more efficiently.
NO CONSISTENT TESTS OR VITAMIN D ‘NORMAL’ LEVEL
Different laboratories utilize various vitamin D assays and there are significant concerns about the agreement of test results. There is no hard and fast reference standard cutoff for what constitutes a low blood vitamin D level (less than 20 ng./ml.? Or less than 30 ng./ml.?) Finally, given these uncertainties, there is no data to support the premise that raising the vitamin D level in someone with a low level will necessarily improve their health. The only exception is a trial that showed giving vitamin D to elderly persons in nursing homes did modestly decrease their mortality rate.
WHAT IS AN INFORMED HEALTH CARE CONSUMER TO DO?
If you have documented osteoporosis or a problem absorbing your food, measuring your vitamin D level can be quite important. For the rest of us, my skeptical “less is better approach” would suggest that there is a better may to spend $100-$150 than buying a vitamin D test. Focus on eating foods with lots of Vitamin D (egg yolks, tuna, mackerel, salmon and vitamin D fortified milk and orange juice). Sunshine in modest doses is a “natural” way to increase vitamin D levels as well.
Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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